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A Guide to Understanding, Preventing, and Treating STIs, STDs, and HIV

With resources for further reading

A Guide to Understanding, Preventing, and Treating STIs, STDs, and HIV

I. Setting the Stage: Why We Talk About Sexual Health

Sexual health is a fundamental component of overall well-being, yet conversations about sexually transmitted infections (STIs) often remain shrouded in fear and misinformation. Historically, this subject has been linked to shame, which, in turn, acts as a significant barrier to effective public health initiatives and prevents individuals from seeking necessary testing and treatment.1 | 2

A. Language Usage and Destigmatization

In contemporary medical and public health education, there is a mandatory shift toward using language that is accurate, specific, non-judgmental, and inclusive. Stigma is not merely a social problem; it is a clinical problem that drives people away from care. By adopting empowering terminology, professionals seek to build trust and increase adherence to care plans.3 | 4


A key example involves using person-first language. Instead of defining an individual by their diagnosis (e.g., "HIV patient" or "carrier"), experts refer to a "person living with HIV" or an "HIV-positive person". This approach reinforces that an individual is not powerless and prevents negatively defining people by their health condition, which can otherwise segregate them. Similarly, language should focus on the likelihood of transmission or acquisition, rather than judgmental terms like "risky" or "unsafe" behavior. When treatment plans are not followed perfectly, it is more productive to assess why "the treatment plan isn't working for them," rather than labeling a patient as "non-compliant" or "non-adherent," which implies individual failure rather than systemic or personal barriers. 1 2 3

B. Addressing Structural Barriers and Commonality

Sexually transmitted infections are highly common across all populations. Annually, the United States continues to report millions of cases. In 2024 alone, there were still over 2.2 million reported cases of Chlamydia, Gonorrhea, and Syphilis, and overall cases remain 13% higher than a decade ago. A diagnosis of an STI should be viewed as a manageable health condition, as many are curable and chronic viral infections are highly treatable and manageable. 5 6


It is also crucial to acknowledge that health disparities observed in STI rates—often by race, ethnicity, or socioeconomic status—are not simply due to individual choices. These disparities are driven by long-standing systemic contributors that impede equitable access to care, such as systemic racism and challenges with social determinants of health. Public health reporting methodologies increasingly emphasize interpreting rate differences with caution, recognizing that structural failures rather than purely individual behavior often determine who is most impacted. 7

II. Definitions and Distinctions: Understanding the Terminology

Precise terminology is vital for accurate public health messaging and clinical guidance. While the terms "STI" and "STD" are often used interchangeably, there is a clear medical distinction that helps clarify the importance of testing.

STI vs. STD: Clarifying the Modern Terminology

The modern clinical standard favors the term Sexually Transmitted Infection (STI). This term refers specifically to the presence of a pathogen (such as a virus, bacteria, fungus, or parasite) that causes infection through sexual contact.8 9


The older term, Sexually Transmitted Disease (STD), implies that the infection has progressed to a recognizable state of illness, displaying symptoms, or leading to adverse health outcomes. 9


The clinical preference for STI is strategic: many infections, such as Chlamydia or Gonorrhea, are entirely asymptomatic. By focusing on Infection (STI), the medical community emphasizes that a person can be infected, still transmit the pathogen, and require treatment even if they show no symptoms of Disease (STD). This normalization is intended to compel sexually active individuals to prioritize screening regardless of perceived health status, thus preventing the progression from a symptomless infection to a serious disease state. For instance, untreated Gonorrhea in women can lead to pelvic inflammatory disease (PID), which may result in infertility. 6


Table 1: STI vs. STD Terminology Comparison

Feature Sexually Transmitted Infection (STI) Sexually Transmitted Disease (STD)
Definition Presence of a pathogen (virus, bacteria, parasite) acquired via sexual contact. A recognizable disease state or set of symptoms resulting from an untreated STI.
Symptoms Often asymptomatic (no visible symptoms or illness). Implies symptoms or health complications have developed.
Medical Preference Preferred term, as infection can be present without active disease or symptoms. Less common term, often perceived as stigmatizing.

See more info 6 10

HIV, AIDS, and Viral Suppression

Human Immunodeficiency Virus (HIV) is one specific type of STI. The virus targets and gradually destroys the immune system's T-cells, leaving the body vulnerable to opportunistic infections. 11


Acquired Immunodeficiency Syndrome (AIDS) is the late-stage condition that develops when the HIV infection is left untreated and the immune system becomes severely compromised. 6 11

A significant achievement in modern medicine is the development of highly effective Antiretroviral Therapy (ART). These medicines control the HIV infection and prevent it from advancing to AIDS. Consequently, progression from HIV infection to AIDS is largely preventable today, underscoring the vital importance of early diagnosis and consistent medication adherence. 11 6

III. How Infections Spread: Understanding Transmission Routes

Understanding how infections are transmitted involves recognizing both the common sexual routes and the less frequent, non-sexual pathways.

Primary Routes: Sexual Contact and Fluid Exchange

The majority of STIs are spread during various forms of sexual activity, including vaginal, oral, and anal sex. The exchange of bodily fluids—including semen, vaginal fluids, pre-ejaculate, rectal fluids, and blood—is the main mechanism of transmission. 6 10 12 3


It is important to note that many STIs do not require penetration or ejaculation for transmission. Some STIs, such as Human Papillomavirus (HPV), Herpes, and Syphilis, are spread by skin-to-skin contact with an infected area, sore, or mucous membrane. For instance, genital herpes can be transmitted through contact with herpes sores or infected skin, even when no symptoms are currently visible, and HPV can be transmitted via skin-on-skin contact in areas not covered by a condom. 12 13 14

Non-Sexual and Perinatal Transmission Pathways

While sexual contact is the primary route, some STIs can spread through non-sexual routes, primarily involving blood, needles, or vertical transmission from a parent to a child.


Bloodborne STIs: Infections like HIV and Hepatitis B and C can be transmitted through contact with infected blood. The most common non-sexual route today is the sharing of contaminated needles or syringes, often associated with injection drug use. Less common, but still possible, are instances of transmission through shared personal items that have blood traces, such as razors or toothbrushes, if a bloodborne infection is present. Certain surfaces like unwashed sex toys, which may harbor infected fluids, can transmit STIs like Chlamydia, Gonorrhea, and Herpes. 11 15 16 13


Vertical Transmission (Parent-to-Child): STIs can be passed from a mother to a child during pregnancy, childbirth, or breastfeeding. This route affects infections like HIV, Hepatitis B, and most notably, Syphilis. 12 17


The extreme rise in congenital syphilis (CS) is a major public health concern. Reported cases of CS have risen drastically—nearly 700% over the last decade. This dramatic increase highlights a critical failure in systemic healthcare access and prioritization. Congenital syphilis is entirely preventable if the pregnant person receives timely treatment. A surge of this magnitude points toward structural failures: inadequate access to universal prenatal STI screening, treatment delays, and resource limitations (such as the current shortage of first-line syphilis medication, discussed below). Addressing this issue requires structural intervention, not simply focusing on individual behavior. 5 17 7 18

IV. Clarifying the Myths: Separation of Fact from Fiction

Misinformation about STI transmission can either breed unnecessary fear or lead to dangerous complacency. It is essential to delineate what is medically possible from what are persistent myths.

The "Proxy" Exposure Question: Debunking Myths

The concept of "proxy" or "by-proxy" exposure refers to whether infections can be acquired indirectly through shared items or casual contact.


Medically, most STI pathogens are fragile and generally cannot survive for long outside the protective environment of the human body. Consequently, STIs are not transmitted through casual contact with inanimate objects or environmental exposures such as:

Nuance Regarding Kissing: While dry kissing is considered safe, deep, wet kissing may rarely transmit infections like oral herpes (HSV-1) or, less commonly, Syphilis or Gonorrhea if active lesions or infections are present in the mouth or throat. However, STIs are not generally transmitted this way 17 13


For the rare instances where non-sexual transmission occurs through shared items (e.g., sex toys, contaminated razors), the pathway requires the presence of active fluids, blood, or sores on the surface, allowing a robust pathogen (like HPV or Hepatitis B) to be transferred. The primary focus of prevention efforts must remain on mitigating risk during sexual contact and fluid exchange. 15 16 6

Contagion Confusion: STIs vs. Common Skin Infections

A frequent area of public confusion involves differentiating true STIs from highly contagious infections that spread through shared, damp surfaces. It is vital for public trust to clearly distinguish these categories.


Common Contagions That Are NOT STIs: Infections like Athlete’s Foot (tinea pedis) are caused by fungi (dermatophytes). These fungi thrive in specific external, non-intimate environments, such as warm, damp floors, locker rooms, and communal showers. Athlete’s foot spreads easily through contact with contaminated surfaces, towels, or shoes, and is highly contagious. However, Athlete’s foot is not a sexually transmitted infection and does not require sexual contact for transmission. The biological mechanism of spread (fungi surviving on external surfaces) is entirely different from the mechanism required for STI pathogens (reliance on mucous membrane contact or bodily fluid exchange). 20 21 17


Skin Conditions That ARE STIs: In contrast, several STIs specifically manifest as lesions, rashes, or growths on the skin or mucous membranes, often resulting from intimate skin-to-skin contact. Examples include: 22



Table 2: Transmission Facts vs. Myths

Exposure Type Medical Fact (Transmission Likelihood) Nuance/Clarification
Vaginal/Anal/Oral Sex High (Primary route for most STIs). Risk level varies by specific STI, use of protection, and frequency.
Skin-to-Skin Contact (Genital) Possible (for STIs like Herpes, HPV, and Syphilis). Requires direct contact with sores, rashes, or infected skin area, not just general touch.
Shared Toilet Seats/Pools None (The pathogens cannot survive outside the body). This is a persistent, unfounded myth. Casual contact is not a transmission route.
Shared Towels/Razors Rare, but possible (for bloodborne or surface-hardy infections). Requires presence of infected blood or fluid (e.g., HIV, Hepatitis B/C) or active sore contact (e.g., Herpes).

See more 14 13 6 17 15

V. Comprehensive Prevention Toolkit: Barrier Methods and Vaccines

Prevention involves a layered approach utilizing barrier methods, biomedical interventions, and vaccinations.

Barrier Methods

Barrier methods physically prevent the exchange of bodily fluids and reduce direct skin-to-skin contact, offering protection against both STIs and unintended pregnancy. 23


External Condoms: These devices, sometimes called male condoms, are worn over the penis to collect ejaculate fluids. They can also be used over inserted sex toys. For optimal protection against STIs, external condoms should be used correctly and consistently every time sexual activity occurs. Users should leave a small space at the tip to collect ejaculate and roll the condom completely to the base. 23 25


Internal Condoms: Sometimes called female condoms, these are flexible sheaths inserted into the vagina or anus. They feature an inner ring that secures the condom inside the body and a soft, flexible outer ring that remains outside the body. It is essential that external and internal condoms are not used simultaneously, as the resulting friction can cause tearing or displacement, increasing the risk of exposure. 23 25


Dental Dams: These thin sheets of material are used as a barrier during oral-vaginal or oral-anal contact to prevent the transmission of pathogens like HPV, herpes, and Hepatitis B.

Vaccination: The Proactive Defense

Vaccines are a proactive and highly effective method for preventing specific viral STIs or severe disease outcomes.

HPV (Human Papillomavirus) Vaccine

The HPV vaccine protects against the types of HPV most commonly associated with cancers (cervical, anal, oral, penile) and genital warts. Routine vaccination is recommended for adolescents at age 11 or 12, though it can be started as early as age 9. 26

  • Adolescent Dosing: Most people who start the series before their 15th birthday require two doses, spaced 6 to 12 months apart. 26 27
  • Young Adult Dosing: Individuals starting the series at age 15 through 26 years require three doses. 26
  • Adult Considerations: Vaccination is not routinely recommended for everyone older than age 26. However, for adults aged 27 through 45 years, clinicians may consider discussing HPV vaccination with people who are most likely to benefit, based on individual clinical risk factors. Immunocompromised persons, including those with HIV, typically require three doses. 26

Hepatitis A and B Vaccines

Hepatitis B Virus (HBV) is a bloodborne infection that is efficiently transmitted through sexual activity.

28
  • Hepatitis B Recommendation: The Advisory Committee on Immunization Practices (ACIP) recommends Hepatitis B vaccination for all adults aged 19–59 years, and for adults aged 60 years and older with risk factors. People seeking treatment in STI clinics—where 10%–40% may have evidence of past or current HBV infection—are identified as a priority population for vaccination. 28
  • Hepatitis A Recommendation: Hepatitis A vaccination is recommended for people at increased risk of infection or severe disease, including men who have sex with men and people living with HIV. Full protection typically requires two or three shots, depending on the specific vaccine type. 29

VI. Biomedical Prevention: PrEP and PEP for HIV

Biomedical prevention methods offer powerful tools to interrupt HIV transmission, moving HIV prevention beyond traditional barrier methods.

A. PrEP (Pre-Exposure Prophylaxis)

PrEP involves the consistent use of HIV medication by HIV-negative individuals to prevent the acquisition of HIV. PrEP can be administered as a daily oral pill or an injection given every two months. 30


When taken as prescribed, PrEP is highly effective at reducing the risk of acquiring HIV through sex or injection drug use. However, PrEP is specific to HIV prevention and does not protect against other STIs (such as Chlamydia, Gonorrhea, or Syphilis). For this reason, individuals using PrEP must still engage in comprehensive sexual health practices, including regular STI screening and, potentially, the use of barrier methods. 30 31


PEP (Post-Exposure Prophylaxis)

PEP is an emergency measure consisting of a 28-day course of a three-drug antiretroviral regimen taken after a possible exposure to HIV. PEP is not intended for regular, ongoing use by people with frequent exposure risk; those individuals should consider PrEP. 30 32


The Critical 72-Hour Window: The efficacy of PEP is highly time-dependent. It must be initiated within 72 hours (three days) of the possible exposure. Clinical guidance emphasizes that "every hour counts," and starting PEP beyond the 72-hour window will most likely not prevent HIV infection. 30


PEP and PrEP Overlap: If a patient who consistently uses PrEP experiences a potential exposure, they typically do not need PEP. However, if a person experiences frequent, recurrent exposures, PEP may be indicated if the most recent exposure was within the 72-hour window. In such cases, the patient may be transitioned to PrEP after completing the 28-day PEP course. 32


Baseline Screening Requirement

Initiating either PrEP or PEP mandates comprehensive baseline screening. This approach ensures safety and promotes holistic sexual health management.


Before a person starts PEP, the Centers for Disease Control and Prevention (CDC) recommends baseline tests including an HIV rapid test (PEP cannot be initiated if the patient is already HIV positive), pregnancy test, liver enzyme test, blood urea nitrogen/creatinine test, and screenings for Hepatitis B (HBV), Hepatitis C (HCV), and other STIs. 32


By integrating STI screening into the PrEP/PEP protocol, clinicians ensure that the biomedical prevention is safely prescribed while simultaneously identifying and treating co-occurring STIs. This integrated testing strategy is essential, as it addresses the fact that PrEP does not protect against other STIs, preventing disease complications and limiting onward transmission of other infections. 32


Table 3: Prevention Strategies at a Glance

Prevention Tool Mechanism of Protection Key Facts
External/Internal Condoms Barrier protection against bodily fluids and most skin-to-skin contact. Effective against STIs and pregnancy. Must be used consistently and correctly.
PrEP (Pre-Exposure Prophylaxis) Daily or event-based oral medication (or injection) that prevents HIV from establishing infection. Requires baseline testing. Only prevents HIV; does not protect against other STIs.
PEP (Post-Exposure Prophylaxis) Emergency 28-day course of medication taken after a potential exposure. Must be started within the critical 72-hour window.
Vaccines (HPV, Hepatitis A/B) Stimulates immunity to prevent infection or severe disease outcomes. Highly effective against specific viruses. Recommended based on age and risk factors.

See more 23 31 30 26 28

VII. Partner Communication and Harm Reduction

Open, honest, and respectful communication with partners is a cornerstone of responsible sexual health. Utilizing a trauma-informed, harm reduction framework optimizes these conversations.

Cultivating Openness and Honesty

Sexual health dialogue should ideally occur before sexual activity so that all parties can make fully informed choices about risk reduction. The key principles for productive partner communication include: 33

  • Be Open and Honest: Share your current STI status, even if you are undergoing treatment, and be transparent about the number of recent partners. 33
  • Be Understanding and Respectful: Approaching the conversation in a non-judgmental manner helps create a safe, productive space for ongoing dialogue. 33
  • Ask About Testing: Inquire when partners were last tested and which infections were included in the screening. 33

This commitment to open communication is crucial not only for mitigating infection risk but also for navigating the complexity of various relationship structures and nurturing mutual understanding.


Utilizing a Trauma-Informed, Harm Reduction Framework

Effective public health messaging moves beyond moralizing language and adopts a harm reduction approach that is grounded in respect and autonomy.

Instead of focusing on "risky" or "unsafe" behavior, which often evokes feelings of shame or guilt, communication should center on the likelihood of acquisition and the practical application of prevention strategies. Labeling behavior as "risky sex" can be stigmatizing; public health experts recommend phrases like "sex without a barrier method/condom/PrEP". 2 4


A trauma-informed framework recognizes that individuals may have complex backgrounds, including histories of interpersonal trauma, which influence their ability to adhere to health recommendations or communicate openly. Comprehensive counseling should facilitate ready access to all prevention methods—including barrier methods, emergency contraception, and PrEP—to allow individuals to select the strategies that work best for their lives and relationship structures. The focus must be on maximizing safety and sexual well-being while respecting the individual's choice and capacity, rather than demanding strict adherence to a single, rigid protocol. 35

VIII. Modern Management: Treatment, Cures, and Viral Suppression

Modern medical advances offer effective treatments for virtually all STIs. Treatment protocols vary significantly depending on whether the infection is bacterial (curable) or viral (manageable/suppressible).


Curable STIs (Bacterial and Parasitic)

Bacterial infections such as Chlamydia, Gonorrhea, and Syphilis, and parasitic infections like Trichomoniasis, are typically curable with a full course of antibiotics. 36


The Syphilis Treatment Crisis: Syphilis remains a serious public health threat, especially in the context of the increase in congenital cases. 5


  • First-Line Standard: Penicillin G Benzathine (Bicillin L-A) is the first-line recommended treatment for syphilis and is the only recommended option for pregnant individuals and infants diagnosed with syphilis. 18 36
  • Current Shortage and Recall: The US healthcare system is currently facing a critical limited supply and a voluntary recall of specific lots of Bicillin L-A due to the presence of particulates. 18 37 38
  • Current Shortage and Recall: The US healthcare system is currently facing a critical limited supply and a voluntary recall of specific lots of Bicillin L-A due to the presence of particulates. 18 38

Follow-Up Care: Following treatment for curable STIs, a test-of-cure may be recommended, particularly for pharyngeal or rectal infections, or if there is concern about treatment adherence or reinfection. 37


Manageable STIs (Viral)

Viral STIs such as HIV and Herpes Simplex Virus (HSV) are chronic conditions that currently have no cure, but they are highly manageable through antiviral medications.

1. Herpes Simplex Virus (HSV) Management

Treatment for genital herpes focuses on managing symptoms, reducing outbreak frequency, and minimizing transmission risk. The FDA-approved antiviral medications include Acyclovir, Valacyclovir, and Famciclovir.

39

Two primary treatment regimens exist:

  • Episodic Therapy: Medication is taken only at the first sign of an outbreak (or prodrome) and continued for several days to speed healing and potentially prevent the outbreak from fully developing. 39
  • Suppressive Therapy: Medication (e.g., Acyclovir or Valacyclovir) is taken daily on an ongoing basis. This approach significantly reduces the frequency of recurrent outbreaks and has the crucial added benefit of decreasing the risk of transmitting HSV-2 to susceptible partners. 40

2. HIV Treatment and U=U (Undetectable = Untransmittable)

HIV treatment relies on Antiretroviral Therapy (ART). These medicines halt the replication of the virus, allowing the immune system to recover. 31

Achieving Viral Suppression: Consistent adherence to ART reduces the amount of HIV in the blood, known as the viral load. Undetectable status is achieved when the viral load is suppressed to a level so low that standard laboratory tests cannot detect the virus, typically requiring at least six consecutive months of undetectable results. 31 41


The U=U Principle: Undetectable = Untransmittable (U=U) is a profound and medically confirmed fact: A person living with HIV who achieves and maintains an undetectable viral load through consistent use of ART has effectively zero risk of sexually transmitting HIV to a partner. Major health organizations, including the CDC and NIAID, publicly confirm this finding. 31 41


This principle is a cornerstone of modern HIV prevention and care, transforming the dialogue from managing constant risk to achieving zero risk of sexual transmission. It is important to emphasize, however, that adherence is essential: if an individual stops taking ART, the viral load can rebound to a detectable level within one to two weeks, and sexual transmission becomes possible again. Furthermore, while U=U prevents sexual transmission of HIV, ART does not protect against other STIs, which still require other prevention strategies. 31 41

IX. Conclusion: Your Empowerment Plan

Taking control of one’s sexual health is an active, ongoing process that is fundamentally an act of self-care and respect for partners. STIs are common, manageable, and highly treatable, and the language used around them should reflect this reality.


Follow-Up

1. Prioritize Regular Testing:

Given that many STIs are entirely asymptomatic, relying solely on symptoms is ineffective. Regular testing—tailored to your sexual history and practices—is the most reliable defense against infection progression and complications. Discuss your testing needs with a healthcare provider and do not hesitate to ask questions about frequency or specific tests. 6 42

2. Utilize Layered Prevention:

Choose prevention strategies that fit your lifestyle and relationships. This toolkit includes barrier methods (external/internal condoms), biomedical prophylaxis (PrEP for those who are HIV-negative), and relevant vaccinations (HPV, Hepatitis A/B). Utilizing these tools together provides the highest level of protection.

3. Communicate Openly:

Commit to honest, respectful, and non-judgmental conversations with your partners about testing status and prevention choices. Empowering communication is a crucial element of sexual well-being and risk management.

If you suspect you have been exposed to HIV, remember the critical 72-hour window for PEP. If you receive an STI diagnosis, seek immediate care; early treatment ensures the best possible health outcomes, and for those living with chronic viral infections like HIV, achieving and maintaining an undetectable status offers personal health benefits while ensuring no sexual transmission risk to partners.

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I. Setting the Stage: Why We Talk About Sexual Health
II. Definitions and Distinctions: Understanding the Terminology
III. How Infections Spread: Understanding Transmission Routes
IV. Clarifying the Myths: Separation of Fact from Fiction
V. Comprehensive Prevention Toolkit: Barrier Methods and Vaccines
VI. Biomedical Prevention: PrEP and PEP for HIV
VII. Partner Communication and Harm Reduction
VIII. Modern Management: Treatment, Cures, and Viral Suppression
IX. Conclusion: Your Empowerment Plan

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Has this post been edited or modified with AI? 1 Yes

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